title: [Diagnostic value of brain biopsy in a pediatric multiple sclerosis mimicking brain stem glioma].
abstract: Diagnosis of multiple sclerosis (MS) is difficult when the lesion mimics glioma or cerebral enchephalitis. We report a case of pediatric MS initially suspected as brain stem glioma. An 11-year-old boy developed left foot joint pain followed by progressive symptoms such as left arm and leg weakness, dysarthria, paraplegia, and decreased level of consciousness. He subsequently developed respiratory distress requiring endotracheal intubation and mechanical ventilation. Magnetic resonance imaging showed a mass measuring 2 cm in the medulla oblongata. Although this mass was initially suspected as a glioma, the patient's acutely progressive disease course was not consistent with this diagnosis. Open biopsy revealed inflammation and demyelination, but no malignant cells were detected. He was treated with steroid pulse therapy, which showed dramatic effects. Nine months later, he developed another episode characterized by several neurological symptoms, and the diagnosis of MS was clinically confirmed. Open brain stem biopsy is technically demanding, but this case demonstrates that appropriate neurosurgical evaluation can play an important role in diagnosis by ruling out glioma and confirming MS.
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: Takanobu
authors.initials: T
authors.lastname: Maekawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Oana
authors.forename: Akira
authors.initials: A
authors.lastname: Ishiguro
authors.forename: Sayaka
authors.initials: S
authors.lastname: Ohta
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Terashima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kashii
authors.forename: Masaya
authors.initials: M
authors.lastname: Kubota
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Atsuko
authors.initials: A
authors.lastname: Nakazawa
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Morota
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sakai
mesh_terms: D001706:Biopsy; D001921:Brain / Q000473:pathology*; D020295:Brain Stem Neoplasms / Q000473:pathology*; D002648:Child; D003937:Diagnosis, Differential; D005910:Glioma / Q000473:pathology*; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000473:pathology*